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Archive for August, 2007

AIDS Activists Rally In South Africa

Posted by pozlife on August 31, 2007


by The Associated Press

Posted: August 30 2007 – 9:00 am ET 

(Cape Town, South Africa) Hundreds of AIDS activists packed the city’s cathedral Wednesday to show support for the dismissed deputy health minister they believe was targeted for speaking out about the AIDS crisis and other problems in the nation’s health service.

Nozizwe Madlala-Routledge, widely credited with revitalizing South Africa’s beleaguered anti-AIDS campaign, was fired earlier this month, accused of taking a business trip to Spain without President Thabo Mbeki’s approval and failing to work as part of a team.

Her dismissal has revived concern about the government’s commitment to fighting the AIDS epidemic, which kills an estimated 900 South Africans each day.

Madlala-Routledge’s firing “is a shame for South Africa. It’s a shame for our beloved country,” said Mpumi Mantangana, a nurse who oversees the treatment of about 2,000 AIDS patients in a poor Cape Town suburb.

“We will never allow ourselves to be silenced by people who are denialists,” she said, using a term for people who question the link between HIV and AIDS and play down the extent of the crisis.

Her remarks were greeted with cheers from the congregation, many of whom wore T-shirts reading “Support Nozizwe Madlala-Routledge. Implement the national HIV/AIDS plan.”

The government says it is committed to achieving the targets in the country’s AIDS plan and has repeatedly insisted the deputy health minister’s dismissal would not affect it.

It has also sent Madlala-Routledge a bill for nearly $62,000 relating to her trip to Spain, and travel and expense payments dating back to 2001. The Treatment Action Campaign and AIDS Law Project have launched a public fund to support Madlala-Routledge.

Madlala-Routledge was one of the driving forces behind an ambitious, five-year plan unveiled earlier this year that aims to halve new infections – currently topping 1,000 per day – and extend treatment to 80 percent of those in need.

But there is mounting concern that the targets will be missed and many activists blame Health Minister Manto Tshabalala-Msimang, who openly criticizes antiretroviral medicines and instead has promoted lemons, garlic and potatoes as AIDS treatments.

Mbeki has vigorously supported Tshabalala-Msimang.

A coalition of church, union and health leaders distributed an open letter Wednesday calling for the South African National AIDS Council to make sure it meets targets set for the end of this year, including putting an additional 120,000 adults and 17,000 children on AIDS drugs.

“Today we once again live in fear that government is in retreat. We fear that denialism about the scale and needs of the HIV crisis is once again ascendant in the health ministry,” it read.

An estimated 5.4 million South Africans are infected with the AIDS virus, the highest total for any country in the world.

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FDA Slows Drug Approval Process

Posted by pozlife on August 27, 2007


by Linda A. Johnson, Associated Press

(Trenton, New Jersey)  Under growing scrutiny since the blockbuster painkiller Vioxx was pulled from the market, the Food and Drug Administration in recent months has rejected a slew of experimental drugs or delayed their approval and required more data.

Besides keeping drugs some patients might desperately need off the market, the rejections have battered drug company stock prices and are expected to increase the cost and time it takes to develop a new drug, not to mention the price of developing future ones.

Denials and delays have hit everyone from pharmaceutical giants such as GlaxoSmithKline PLC, Merck & Co., Novartis AG, Sanofi-Aventis and Wyeth down to struggling startups trying to get their first drug on the market. The FDA also has recently stiffened warnings on several drugs, most prominently diabetes drugs Avandia and Actos, and five months ago made Novartis withdraw its constipation drug, Zelnorm.

“There have been no systematic changes in how we are approaching the approval standards for new applications,” FDA spokesman Christopher Kelly said in an e-mail. “Whether the current public debate and criticism of FDA on drug safety has played any role in our actions is very hard to quantify.”

But Chris Milne, associate director of the Tufts Center for the Study of Drug Development, said Friday the FDA has systematically implemented more controls for scrutinizing drugs, particularly for heart and liver side effects. While he thinks the trend on approvals is not yet clear, he said the FDA now is requiring experimental drugs similar to ones already on sale to be more effective and safer than their predecessors.

Some experts say they already see a trend toward increased rejections, although drugs for life-threatening diseases or conditions with no good current treatment are generally being approved.

“The FDA is being more cautious,” analyst Steve Brozak of WBB Securities said, explaining that FDA staff now realize new drugs will be used by many patients beyond those intended – known as off-label use because the drug is taken for another condition than the one it was approved to treat. That often boosts the chances that some patients will be harmed by side effects.

He sees the FDA mentality now as: “It’s got to be so safe that we’re not going to be criticized ever” for approving a drug.

The agency has approved 61 percent of drug applications through mid-August, down from 73 percent in the same period last year, according to BioMedTracker, a biotech and pharmaceutical research service.

James Kumpel at Friedman, Billings, Ramsey & Co. just published a report showing FDA approvals of “new molecular entities” – drugs made from new chemical compounds rather than just twists on existing drugs – so far this year are at their lowest level in at least a decade. Only seven were approved through the end of July, versus an average of 12 over the first seven months of each year since 1998.

“The FDA certainly has made it more difficult for pharmaceutical companies by pushing for more data and for more participants and for longer studies,” said Kumpel, barriers he said will start limiting the number of new blockbusters.

Already, the average cost of shepherding a potential drug from discovery through approval is $980 million, up from $802 million in 2000, and the process takes 14.2 years on average, according to Tufts.

“It appears that FDA has been on defense since 2004,” Kumpel said.

That’s when Merck withdrew its blockbuster painkiller Vioxx from the market because of increased risk of heart attacks and strokes, making Vioxx an instant poster child for drug safety issues.

Last April, the FDA rejected Merck’s Arcoxia, a long-planned successor to Vioxx on sale in many other countries.

Just Friday, Endo Pharmaceuticals Holdings Inc. said the FDA for the second time asked for more time to review its approved migraine drug Frova for a new use, preventing menstrual migraines.

In between, the FDA has cited safety or effectiveness questions in rejecting or delaying approval for experimental drugs including Novartis’ diabetes drug Galvus, Sanofi-Aventis’ weight-loss drug Zimulti, and even a higher dose of GlaxoSmithKline’s Advair Diskus for bronchitis and emphysema symptoms. Also shot down: Wyeth’s experimental schizophrenia drug bifeprunox and Wyeth’s Pristiq, which would have been the first nonhormonal drug for menopause symptoms.

Likewise, small pharmaceutical companies have been hurt. One, Pozen Inc., this month got its second FDA request for more information about a migraine treatment called Trexima it is jointly developing with GlaxoSmithKline. That news sent Pozen shares down 46 percent.

Scott Gottlieb, an American Enterprise Institute fellow who was FDA deputy commissioner until January, said drug companies have long complained that FDA was too conservative. Now, there’s even more uncertainty both at the agency and in the industry.

For drugs where benefits don’t strongly outweigh risks, Gottlieb said, “The agency errs on the side of caution.”

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New Evidence Of Link Between Meth Use, HIV

Posted by pozlife on August 27, 2007


by 365Gay.com Newscenter Staff

Posted: August 27, 2007 – 3:00 pm ET 

(Winston-Salem, North Carolina) New findings that one in 20 North Carolina men who have sex with men reported using crystal methamphetamine during the previous month suggests increased risk for spreading HIV and other sexually transmitted diseases, according to researchers from Wake Forest University School of Medicine.

The rate of methamphetamine use among 1,189 MSM was 30 times higher than levels reported in the general U.S. population over the same period the researchers said Monday.

Methampehtamine, or “meth,” is a highly addictive stimulant that has been found to impair judgment, decrease inhibition, increase impulsivity and enhance sexual sensitivity – which can all increase the potential for transmitting HIV.

The study’s authors found that participants who reported using methamphetamines were more likely to report inconsistent condom use during anal sex within the past three months, a history of STD infection, being HIV-positive and using medications designed to treat erectile dysfunction.

The study mirrors similar research in California and other parts of the country.

“Until now, there has been little data on meth use in the Southeast,” said lead author Scott D. Rhodes, an associate professor in the Department of Social Sciences and Health Policy. 

“Our findings, including that meth users were more likely to be HIV-positive, suggest that prevention, intervention and treatment efforts are urgently needed.”

Rhodes noted that some of the men reported having sex with both men and women, which means the risk of HIV extends to both sexes.

The study’s results were published in AIDS Patient Care and STDs, a leading AIDS journal that provides the latest research for clinicians and researchers. It is among the first to document meth use among MSM in the South, which carries a disproportionate HIV, AIDS, and STD burden, with 46 percent of newly identified cases.

“The findings underscore the need for further research and intervention,” said Rhodes. “The HIV/AIDS epidemic is clearly not over. We must develop innovative intervention approaches designed to reach communities at highest risk. Men who have sex with men, whether or not they identify themselves as gay, who use drugs like methamphetamines are clearly at higher risk. Yet currently nothing is being done in the Southeast.”

Participants were recruited in 2005 in five gay bars and in five geographically defined internet chat rooms in central North Carolina (primarily rural/suburban areas) and were asked to complete a brief assessment of drug use and other risk behaviors. Of the 1,189 MSM, two-thirds self-identified as black or other minorities, and 25 percent as bisexual. The mean age was 29 years.

In addition to being more inclined to risky sexual behaviors, the study participants who said they used methamphetamines were also more likely to report having higher education and health insurance coverage.

“Because users of methamphetamines were more likely to have higher educational levels and report having health insurance, we must change the way we think about meth users and develop sophisticated prevention strategies that are appropriate for these types of users,” noted Rhodes. “In addition, the link between meth use and the use of drugs for sexual dysfunction among a young population deserves attention. Meth use in combination with one of these medications may be having an even more profound impact on the HIV and STD disease epidemics in the South.”

Rhodes is also affiliated with the Maya Angelou Research Center on Minority Health at Wake Forest.

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Families Burying Alive People With AIDS

Posted by pozlife on August 27, 2007


by 365Gay.com Newscenter Staff

Posted: August 27, 2007 – 3:00 pm ET 

(Sydney, Australia) An HIV/AIDS-care worker in Papua New Guinea says that people with HIV/AIDS are being buried alive in the remote highlands of the island country.

Margaret Marabe tells Radio Australia that she has witnessed several of the burials and that they were done by relatives when those with the virus became too ill to care for.

Marabe is a volunteer with the organization IGAT and has been trying to do AIDS education in Papua New Guinea’s remote Southern Highlands province.

She tells Radio Australia that families resorted to the live burials because they were too poor to help the victims.

“They were crying and calling out their relatives’ names and called for help. Some said ‘Mama Papa’ as they were forcefully buried and covered with soil,” Marabe told the broadcaster.

IGAT has been critical of Papua New Guinea’s National Aids Council for failing to educate people about HIV/AIDS in rural parts of the country.

Papua New Guinea shares an island north of Australia with Indonesia’s easternmost Papua province. 

According to the United Nations it has one of the region’s worst HIV/AIDS epidemics.

The country is plagued by political instability, poverty and rampant sexual violence against women. 

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WHO Ties Rising Population To Rise In AIDS, Other Diseases

Posted by pozlife on August 27, 2007


by The Associated Press

Posted: August 26, 2007 – 4:00 pm ET 

(Geneva)  A ballooning world population, intensive farming practices and changes in sexual behavior have provided a breeding ground for an unprecedented number of emerging diseases, the U.N. health agency says in a new report.

AIDS and 38 other new pathogens are afflicting mankind that were unknown a generation ago, the World Health Organization said.

Though advances in science could account for the discovery of existing pathogens that were previously unidentified, WHO epidemics expert Dr. Mike Ryan said changes in human behavior and practices have produced more new diseases.

“We’ve seen a shift in trend that reflects a transition of human civilization,” Ryan said. “The relationship to the animal kingdom, our travel, our social, sexual and other behaviors have changed the nature of our relationship with the microbial world and the result of that is the emergence of new pathogens and the spread of those pathogens around the world.”

He noted that in the late 19th century, scientists discovered a range of agents causing ancient scourges such as anthrax, staphylococcus, tuberculosis and tetanus.

In the 1970s and 80s it wasn’t pathogens experts were discovering but new syndromes: children getting sick with rashes and fever in the suburban areas of the Americas, people suffering from liver and renal disease after consuming undercooked meat.

“We’ve urbanized a world. We have moved people and food around that world at ever increasing speed,” Ryan said. “We’re not saying that’s a bad thing. What we’re saying is that we must recognize the risk we create in the process and invest to manage those risks.”

WHO Director-General Dr. Margaret Chan said one of the changes affecting human health was increasingly intensive poultry farming, which may account for the global spread of bird flu.

“It should not come as a surprise that we are seeing more and more disease outbreaks coming from the animal sector,” Chan said.

She said the majority of the 39 new diseases came from animals, including Ebola, SARS, and bird flu.

Much of WHO’s annual report on the state of the world’s health was designed to convince governments to adhere to new, tighter International Health Regulations, providing the basis for the world to cooperate in combating frightening diseases.

WHO also said Thursday that it was working to fast-track improvements of food and products regulation in China, whose exports have become a source of safety concern in recent months.

“The Food and Safety department of the World Health Organization in Geneva has been working with the government of China to streamline their regulation of food and products,” Chan said. “And actually they have been in touch with our colleagues again to take their initial discuss forward.

“The process has been going on for some time … and recently we were approached to see in what way we can strengthen and fast-track that process.”

Chan announced a special experts meeting in Beijing scheduled for mid-September.

“The government of China is committed to improving their system,” she added.

Chinese exports have come under intense scrutiny, especially in the United States, China’s most important export market. Regulators have turned up tainted pet-food ingredients, seafood and toothpaste with potentially dangerous chemicals and drugs.

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AIDS Group Fundraiser Claims He Was Fired For Not Being Gay

Posted by pozlife on August 27, 2007


by 365Gay.com Newscenter Staff

Posted: August 27, 2007 – 1:00 pm ET 

(Los Angeles, California) A man hired to oversee fundraising for a cycling event that raises money for two California AIDS groups says he was fired because is straight according to a lawsuit filed in Los Angeles.

Jeffrey Shapiro is suing the Los Angeles Gay and Lesbian Community Services Center and the San Francisco AIDS Foundation.

The two groups produce AIDS/LifeCycle, the 545-mile cycling event to that funds the groups and helps in the fight against HIV/AIDS.

In documents submitted to the Los Angeles Superior Court Shapiro claims discrimination based on his sexual orientation and intentional infliction of emotional distress.

The lawsuit alleges that leads of the LAGLC and SFAF leaders fired Shapiro in June. He claims in the suit that he was told “everybody liked him as a person, but they needed somebody who better fit into the culture.”

The court papers also say that when Shapiro he asked for a further explanation a LAGLC director told him “things like this happen and that they made a mistake to think this could work.”

Shapiro said he was given two weeks severance pay plus money for unused vacation time.

The lawsuit claims that his work generated a record $11 million for the two groups compared to $8 million in the previous year.

Shapiro is seeking unspecified compensatory and punitive damages plus a permanent injunction preventing the two groups “from engaging in further such discrimination.”

Neither the LAGLC nor the SFAF have yet responded to the suit.

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China Admits Failure In Safe Sex Message

Posted by pozlife on August 20, 2007


by 365Gay.com Newscenter Staff

Posted: August 20, 2007 – 11:00 am ET 

(Beijing) The Chinese government acknowledged Monday for the first time that unsafe sex has surpassed illegal drug use as the main cause of HIV infections.

Until now the Ministry of Health has maintained that injecting illegal drugs was the main reason for a growing number of cases of HIV/AIDS.

The MOH on Monday said that in 2005, the most recent year that it has full statistics for, there were were 70,000 new cases of HIV.  Almost fifty-percent were through sexual contact.

Injected drug use ranked second, accounting for 48.6 percent the ministry said.

“It’s the first time since 1989 when the first HIV infection was detected for sex to top the transmission list nationwide,” Gao Qi, a project manager with Beijing-based China HIV/AIDS Information Network told the English language China Daily.

The statistics show that the virus is now entering the general population, despite government programs aimed at educating people about the virus. They also suggest that two groups are helping fuel the transfer to the general public – prostitution and closeted men who have sex with men but who are married.

Prostitution, which is rampant in China and hard to control, has been linked to illegal drug use.  Many prostitutes are intravenous drug users who contract HIV and then pass the virus to clients through unsafe sex.

A large proportion of China’s deeply closeted gay community is in opposite-sex relationships.

Until recently the government has failed to target either group for safe sex education.

In April the government for the first time held a free HIV/AIDS testing clinic for gay men in Beijing. Only about 200 gay men turned out.

In June the government began enlisting gay bars in Beijing to educate people about safe sex. (story)  The bars, clubs, health centers and massage parlors are handing out free condoms and literature to customers.

The government said in announcing the Beijing program that the number of men who have sex with men contracting HIV has steadily grown over the past three years.  The official infection rate was 1.5 percent of the population in 2004 but has now grown to almost 7 percent.

Western health authorities say the official rate is lower than the real numbers. China consistently has said it has fewer people living with HIV/AIDS than projections from the United Nations indicate.

The Joint UN Program on HIV/AIDS, or UNAIDS, has warned that up to 10 million people in China could be infected by 2010 without more aggressive prevention measures.

A report issued in March by China’s Ministry of Health showed that only about 30 percent of the country’s college students have a full understanding of HIV/AIDS. 

Some areas of the country continue to suppress safe-sex education.

Earlier this month Henan province, in central China, barred AIDS activists from holding a meeting to discuss ways of educating the public about the virus. (story)

©365Gay.com 2007

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Bush Official Praises South Africa Controversial AIDS Plan

Posted by pozlife on August 20, 2007


by The Associated Press

Posted: August 20, 2007 – 9:00 am ET 

(Johannesburg, South Africa) The top U.S. health official praised South Africa’s new national AIDS plan on Sunday, but sidestepped questions about the dismissal of a deputy minister seen as a driving force behind the country’s program.

South Africa’s five-year plan, launched earlier this year, aims to reduce the number of new HIV infections and to extend treatment to 80 percent of those with AIDS by 2011. South Africa “has constructed a good plan,” Mike Leavitt, the U.S. secretary of health and human services, said at the start of his visit. “Now it must be executed in a way that makes good on the prospects it offers and the hope it can provide.”

Nearly 1,000 people die of AIDS each day and an estimated 1,400 are newly infected with the virus that causes AIDS every day. The government has said it is concerned about the increasing costs of anti-retroviral drugs.

Leavitt was on a four-nation tour to highlight U.S. health care programs in Africa, with a focus on HIV/AIDS and malaria. His visit follows President Bush’s call to Congress to double the initial $15 billion funding of the President’s Emergency Plan for AIDS Relief, or PEPFAR.

The program helps provide treatment for 1.1 million people worldwide, with more than a million in Africa. But it has been criticized for emphasizing abstinence and fidelity over the use of condoms in its prevention efforts.

The U.S. has invested $600 million this year in South Africa, where an estimated 5.4 million people are infected with the AIDS virus, the second highest total in the world after India.

There is concern the government’s plan could be undermined after South African President Thabo Mbeki – who has long been accused of playing down the AIDS epidemic – fired Nozizwe Madlala-Routledge as deputy health minister.

Madlala-Routledge had won widespread praise for her work in drawing up the new plan. Her boss, Health Minister Manto Tshabalala-Msimang, has been seen as a destructive force because she has questioned the efficacy of AIDS drugs and instead promoted beets and garlic as a remedy.

Mbeki said he fired Madlala-Routledge because she was incapable of working as part of a team.

Leavitt would not comment on the dismissal, but warned that “any country that does not aggressively move” to address the epidemic “will bear the unhappy results.”

Briefing reporters, he said he would not be meeting with Tshabalala-Msimang as he had been informed she would be out of the country, and instead would meet with the minister for social development and officials from the health department.

Leavitt will be in South Africa until August 21 before traveling to Mozambique, Tanzania and Rwanda.

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Mbeki Defends Controversial AIDS Plan

Posted by pozlife on August 20, 2007


by The Associated Press

Posted: August 18, 2007 – 9:00 am ET 

(Cape Town, South Africa) South African President Thabo Mbeki – who has long been accused of playing down the AIDS epidemic – has hit back at criticism of his government’s policy and his firing of the popular deputy health minister.

In his weekly column, Mbeki said that he would not be pressured by the “ill-intentioned and ill-founded hue and cry” about the dismissal of Nozizwe Madlala-Routledge. The deputy minister had won widespread praise for revitalizing the country’s anti-AIDS campaign, while her boss, the health minister, has been seen as a destructive force because she has questioned the efficacy of AIDS drugs and instead promoted beets and garlic as a remedy.

Mbeki fired her last week, saying she was incapable of working as part of a team. Domestic and international critics, who have long called for the dismissal of health minister Manto Tshabalala-Msimang, said he had fired the wrong person.

An estimated 5.4 million South Africans are infected with the AIDS virus, the second highest total in the world after India. About 900 people die each day and an estimated 1,400 people are newly infected, according to the Medical Research Council, which predicts that fewer than half the country’s 15 year-olds will live to see their 60th birthday.

Critics have accused Mbeki of denying the link between HIV and AIDS and turning a blind eye to the devastation the epidemic is wreaking in South Africa.

Stephen Lewis, the recently retired U.N. envoy on AIDS in Africa, on Wednesday said of Mbeki: “I’ll never understand his disastrous response to the AIDS virus. I don’t think I’ve ever met anyone, inside or outside of South Africa, who fully understands.

“After all,” Lewis wrote in an opinion piece for South African newspapers, “this is a man of immense intelligence, who fought against apartheid with every intellectual and organizational weapon at his command. But his place in the annals of South Africa is forever sullied by the inexplicable unwillingness to confront HIV/AIDS.”

In his weekly column distributed by his office Friday, Mbeki said the government had launched an ambitious AIDS prevention and treatment policy – and that this was not purely the work of Madlala-Routledge.

And he insisted that all government members must toe the party line.

He said the depiction by AIDS activists and international commentators of Madlala-Routledge as a heroine for daring to speak out undermined the ANC’s principles of collective responsibility.

“None of the members of the ANC deployed in government will be treated by our movement as heroes and heroines on the basis of “lone ranger” behavior, so-called because of their defiance of agreed positions and procedures of our movement and government,” he said.

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Health Clinics Go Retail

Posted by pozlife on August 17, 2007


by Anne D’Innocenzio, Associated Press

Increasingly, American consumers are shopping for health care the way they buy a hamburger or milk shake at a fast-food chain: By standing in line at a local store under a menu.

Store-based health clinics – which are staffed mostly by nurse practitioners and offer quick services for routine conditions from colds and bladder infections to sunburn – aren’t just a health care fad anymore, but fast becoming a serious industry.

About 7 percent of Americans have tried a clinic at least once, according to an estimate by the Convenient Care Association, an industry trade group formed last year. That number is expected to increase dramatically, as major pharmacy operators like Wal-Mart Stores Inc., CVS Corp., Target Corp. and Walgreen Co., partner with miniclinic providers like RediClinic and MinuteClinic to expand operations. The trade group estimated there will be more than 700 by year-end, up from the more than 400 now, and 2,000 by the end of 2008.

With the nation’s $2 trillion health care system in need of repair, such an express approach to health care – which offers a wait time averaging about 15 minutes and evening and weekend hours – is being heralded as serving up a cheaper and quicker alternative than a doctor’s office or an emergency room. A physical exam costs on average $60, while a flu shot typically costs about $20. A strep throat test has a price tag of about $15.

“I was frankly very impressed with how thorough (the examination) was,” said Susan Anthony, who visited a clinic at a Phoenix, Md., Target for a dry cough. “And it was fast. I walked in at 10:30 a.m. and was in my car a little after 11:00 a.m.”

The American Medical Association said a growing number of medical practices are extending their office hours or forming their own clinics to compete. But concerns about quality of care are rising among physicians and some industry experts say the clinics’ services need to be more comprehensive if they are going to have a big impact on reducing overall health care costs.

The competition is already spawning expanded services as well as new spinoffs. Consumer Health Services Inc. – founded by a former investor of MinuteClinic, considered the pioneer in the industry – just started rolling out walk-in doctor’s offices at Duane Reade Inc. drugstores in the New York City area. The clinics offer broader services that include wart removal and treatment for sprained ankles.

The ventures are promising enough that big-shot investors are jumping into the game. RediClinic got an undisclosed cash infusion from Revolution LLC, the investment house launched by AOL founder Steve Case.

Support among health insurance companies is also growing; about 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA.

“(Store-based clinics) provide another access point for our members,” said Allen Karp, vice president of health care delivery for Aetna.

But concerns are rising in the medical industry that these operations remain largely unregulated and are prone to conflicts of interest. Some physicians are also concerned that the clinics could disrupt the continuity of care and result in serious underlying health conditions going undetected.

In June, the American Medical Association urged state and federal agencies to look into whether pharmacy chain-owned clinics urge patients to get their prescriptions filled on site. That followed buyouts of miniclinics by two big-name pharmacy operators: Walgreen bought Conshohocken, Pa.-based Take Care Health Systems in June, and CVS acquired Minneapolis-based MinuteClinic last year.

Dr. Peter Carmel, a trustee on the AMA board, said “the path of abuse is wide open,” and the clinics need to be better regulated.

A growing number of states have passed legislation to better define the role of the nurse practitioner at these clinics, but store-based clinic executives say some of the state rules are too burdensome and hinder growth. According to the American College of Nurse Practitioners, approximately 23 states allow nurse practitioners to treat patients on their own. The remainder requires some formal relationship with a physician, which varies from supervision to collaboration. In Texas, for example, the physician is required to be at the site for 20 percent of the time a clinic is open.

Store-based health clinics are held to the same high standards as doctors’ offices, said Tine Hansen-Turten, executive director of the Convenient Care Association. She pointed out that store clinics are either monitored by a state board of nursing or board of medicine, and sometimes by both.

AMA also wants to ban the practice of health insurance companies waiving or lowering co-payments for clinic patients, which it calls a conflict of interest.

Dr. David Plocher, the senior medical officer at Blue Cross Blue Shield of Minnesota, said that “the normal market forces should determine such things.” His company has reduced or waived co-payments for 25 member companies who use MinuteClinics and several other store-based clinics.

The savings can be significant.

A visit to a store-based clinic averages about $60, but a doctor’s visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Barnett.

About 40 percent to 50 percent of clinics take insurance. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.

Like many of his industry peers, Michael Howe, president and CEO of MinuteClinic, said the concerns about quality are overblown.

“I wouldn’t call it express care. I would call it efficient care,” added Howe.

The AMA denies that its criticism of these clinics is being driven by economic interests, though there’s no doubt that primary physicians could lose some business as their insured patients go elsewhere for minor ailments.

But health care consultants say that while the clinics may help save customers money and time, their ability to reduce overall health care costs will probably be limited given that they are really tackling the most minor of health problems.

A bigger effect lies in increased worker availability as employees don’t have to take as much time out of their work schedules to go to a doctor’s office, according to Dr. Tim Newman, senior medical consultant for Watson Wyatt Worldwide.

The growing number of onsite clinics at workplaces, staffed by physicians, actually have more of a potential to reduce overall health care costs since they focus on disease management, not episodic illnesses. The onsite clinics are not part of the Convenient Care Association’s total count, since they are not store-based clinics and have a different model.

Store clinics are proving to be good business; they take about 12 to 18 months to break even. For retailers, the highest-margin products continue to be pharmaceutical, and clinics average about one drug prescription per patient, according to clinic providers. Also, stores can enjoy additional sales when sick customers pick up other items.

But it’s still big challenge to gain trust among consumers wary about being treated at a local drug store. Dr. Susan Bowers-Johnson, the medical director for the current four clinic locations at Duane Reade, said that a father recently brought in his 4-year-old child who had a sore on his hand. He said if she was going to prescribe antibiotics, he would rather get them through his family physician.

“Many people are skeptical,” she acknowledged.

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